(Reproduce Freely But Acknowledge Source.) : Abingdon Road, Oxford Oxi 4Xd
(Reproduce Freely But Acknowledge Source.) : Abingdon Road, Oxford Oxi 4Xd
COPYRIGHT: RIVERMEAD REHABILITATION CENTRE, ABINGDON ROAD, OXFORD OXI 4XD. (Reproduce freely but acknowledge source.)
PATIENT'S NAME:
HOSPITAL NUMBER:
Score 0 = No 1. 2.
1 = Yes
DATE
Do you turn over from your back to your side without help? From lying in bed, are you able to get up to sit on the edge of the bed on your own? Could you sit on the edge of the bed without holding on for 10 seconds? Can you (using hands and an aid if necessary) stand up from a chair in less than 15 seconds, and stand there for 15 seconds, Observe patient standing for 10 seconds without any aid. Are you able to move from bed to chair and back without any help?
3.
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5. 6.
7. Can you walk 10 metres with an aid if necessary but with no standby help? 8. Can you manage a flight of steps alone, without help? 9. Do you walk around outside alone, on pavements? 10. Can you walk 10 metres inside with no caliper, splint or aid and no standby help? 11. If you drop something on the floor, can you manage to walk 5 metres to pick it up and walk back? 12. Can you walk over uneven ground (grass, gravel, dirt, snow or ice) without help? 13. Can you get in and out of a shower or bath unsupervised, and wash yourself? 14. Are you able to climb up and down four steps with no rail but using an aid if necessary? 15. Could you run 10 metres in 4 seconds without limping? (A fast walk is acceptable.) TOTAL